Work on advice has concentrated on institutional settings where there are restrictions on roles, actions and their organisation. This article focuses on advice giving in mundane settings: interactions between mothers and their young-adult daughters in a corpus of 51 telephone calls. Analysis reveals a range of designs that can be ‘advice implicative’ including advice-implicative interrogatives and advice-implicative assessments. Recipients orient to the characteristic features these implicit forms share with more explicit advice: normative pressure on the recipient’s conduct and epistemic asymmetry (...) between advisor and advisee. Advice-implicative actions orient to contingencies on the recipient’s ability or willingness to perform the target action. They also display varying degrees of entitlement over the recipient’s performance of the target action. Manipulating contingency and entitlement can soften or heighten both the normative thrust and the knowledge asymmetry of the advice giving. This analysis further discusses the distinction between the practices of advising, directing and requesting, and allows consideration of how action design connects to relationality between parties. (shrink)

Natural languages contain many layers of sequential structure, from the distribution of phonemes within words to the distribution of phrases within utterances. However, most research modeling language acquisition using artificial languages has focused on only one type of distributional structure at a time. In two experiments, we investigated adult learning of an artificial language that contains dependencies between both adjacent and non-adjacent words. We found that learners rapidly acquired both types of regularities and that the strength of the adjacent statistics (...) influenced learning of both adjacent and non-adjacent dependencies. Additionally, though accuracy was similar for both types of structure, participants’ knowledge of the deterministic non-adjacent dependencies was more explicit than their knowledge of the probabilistic adjacent dependencies. The results are discussed in the context of current theories of statistical learning and language acquisition. (shrink)

The article explores the challenges of ensuring voluntary and informed consent which is obtained from potential research subjects in the north‐eastern part of Romania. This study is one of the first empirical papers of this nature in Romania. The study used a quantitative survey design using the adapted Quality of Informed Consent (QuIC) questionnaire. The target population consisted of 100 adult persons who voluntarily enrolled in clinical trials. The informed consent form must contain details regarding the potential risks and benefits, (...) the aim of the clinical trial, study design, confidentiality, insurance and contact details in case of additional questions. Our study confirmed that although all required information was included in the ICF, few clinical trial participants truly understood it. We also found that the most important predictive factor for a good subjective and objective understanding of the clinical trial was the level of education. Our study suggests that researchers should consider putting more effort in order to help clinical trials participants achieve a better understanding of the informed consent. In this way they will ensure that participants’ decision‐making is meaningful and that their interests are protected. (shrink)

We propose a way to achieve across-population sharing within the authors' model in a way that is plausibly in accordance with human evolution, and also a simple way to capture ecological structure. Finally, we briefly reflect on the model's scope and limits in modeling linguistic communication.

The public sphere has been seen by conservatives as an arena for safeguarding private relations. Private power relations could be threatened by newly recognized social groups that make claims on the state for justice and equality. Therefore, conservatives have been concerned about who can speak and exist in public and who can thereby make demands on the state. In the debates over transgender rights in Canada, social conservatives and neoliberal forces have merged in complex and impactful ways. Analyzing House of (...) Commons and Senate debates and committee proceedings for Bill C-279 and Bill C-16, I examine three conservative arguments that illustrate attempts to maintain private power relations and hierarchal gendered divisions by ensuring that transgender and gender nonconforming people are not allowed to exist, speak or make claims in public: first, the assertion that gender identity and gender expression are not definable identity categories for claims-making because transgender people are deceptive and can change their gender based on their feelings; second, the targeting of public facilities, and particularly public bathrooms, as sites of contention, danger and necessary gender segregation; and third, the attempt to delegitimize rights claims by criminalizing transgender people in relation to cisgender women and children. (shrink)

On November 4, 2008 California voters passed Proposition 8, and accordingly same-sex marriage was banned under the state constitution. Proposition 8 is now being considered by the Supreme Court. The proposition has sparked national debate about the nature of the relationship between the state and citizens’ sexuality and corresponding rights; calling into question the practice of allocating rights and privileges on the basis of sexuality and family form. Proponents of the proposition, who can be classified as predominantly socially conservative, want (...) to maintain the status and privileges of marriage for heterosexuals; arguing that allowing same-sex marriage threatens the legitimacy, sanctity and strength of traditional heterosexual marriage . This article examines the extent to which three Californian pro-same-sex marriage organizations (Equality California, Join the Impact, and the Courage Campaign) have challenged and/or appropriated social conservative and neoliberal discourses in their effort to gain access to the rights and privileges that are currently administered through marriage. (shrink)

Patterns of memory sharing begin early in one’s life, informing relationships, one’s history, and one’s sense of cultural belonging. Memory sharing among families has been the focus of research investigating the relationship between mental health and intergenerational memory. A burgeoning body of research is showing that intergenerational knowledge of one’s family history is associated with positive mental health and wellbeing. However, research on the specific mechanisms and potential applications of such findings are just beginning to emerge. In particular, studies examining (...) intergenerational storytelling point to the importance of culture and gender as critical factors underlying how stories are told and the extent to which these stories are associated with wellbeing. Such findings hold important promise for the pentation and treatment of mental health issues. As research in this area continues to evolve, the identification and characterization of factors and mechanisms underlying intergenerational family stories and wellbeing may help to guide the integration of family stories into mental health interventions. (shrink)

Open-ended interviews remain the default data generation technique for qualitative psychology and sociology. This commentary raises questions with Griffin's understanding of naturalistic materials and the emic/ etic distinction. It reiterates problems in the use of open-ended interviews, and repeats the case for more considered support for their use.

The affect heuristic and implicit attitudes are two separate concepts that have arisen within different literatures but that have a number of similarities. This paper compares these two constructs with the aim of clarifying exactly what they are and how these relate to one another. By comparing and contrasting the affect heuristic and implicit attitudes we conclude that the “affect pool” of images tagged with feelings referred to within the affect heuristic literature may be equivalent to the construct of implicit (...) attitudes. Further to this, the affect heuristic itself could be considered as a specific subtype of spontaneous process that is driven by implicit attitudes. We propose that each of the implicit attitude and affect heuristic constructs could be further developed through the examination and comparison of existing literatures surrounding the other. Implications for future research are outlined. (shrink)

The emergence of ethical concerns surrounding artificial intelligence (AI) has led to an explosion of high-level ethical principles being published by a wide range of public and private organizations. However, there is a need to consider how AI developers can be practically assisted to anticipate, identify and address ethical issues regarding AI technologies. This is particularly important in the development of AI intended for healthcare settings, where applications will often interact directly with patients in various states of vulnerability. In this (...) paper, we propose that an ‘embedded ethics’ approach, in which ethicists and developers together address ethical issues via an iterative and continuous process from the outset of development, could be an effective means of integrating robust ethical considerations into the practical development of medical AI. (shrink)

Teeth are one of the most fascinating innovations of vertebrates. Their diversity of shape, size, location, and number in vertebrates is astonishing. If the molecular mechanisms underlying the morphogenesis of individual teeth are now relatively well understood, thanks to the detailed experimental work that has been performed in model organisms (mainly mouse and zebrafish), the mechanisms that control the organization of the dentition are still a mystery. Mammals display simplified dentitions when compared to other vertebrates with only a single tooth (...) row positioned in the anterior part of the mouth, whereas other vertebrates exhibit tooth rows in many locations. As proposed 60 years ago, tooth rows can be formed sequentially from an initiator tooth. Recent results in zebrafish have now largely confirmed this hypothesis. Here this observation is generalized upon and it is suggested that in most vertebrates tooth rows could form sequentially from a single initiator tooth. (shrink)

Through a multiphase coding process, the researchers examined the selection, characteristics, and planned use of 111 written, visual, oral, and material sources that preservice teachers incorporated into plans for inquiry-based elementary social studies instruction. Preservice teachers identified Google as their main tool for locating potential sources, selected far more secondary than primary sources, and varied widely in how they prepared sources for elementary students. Planned use of sources focused almost entirely on identifying key details, with limited opportunities designed for students (...) to contextualize sources, examine bias, or corroborate evidence. Implications for teacher education related to source selection and analysis are discussed. (shrink)

This article defends the idea of applying principles of corrective justice to the matter of climate change. In particular, it argues against the excusable ignorance objection, which holds that historical emissions produced at a time when our knowledge of climate change was insufficient ought to be removed from the equation when applying rectificatory principles to this context. In constructing my argument, I rely on a particular interpretation of rectificatory justice and outcome responsibility. I also address the individualism objection by showing (...) why we should view states as relevant agents of climate change. This argument is built on the assumption that states are institutions set up to coordinate and regulate human interaction, so as to protect their citizens from the unwanted consequences of such interaction. (shrink)

While the low conviction rate for cases of sexual violence is often justified by the so-called ‘he-said-she-said’ nature of these cases, the increasing presence of digital evidence has begun to challenge this justification. This digital evidence can provide new opportunities for intervening in and prosecuting sexual violence. However, it may also be used against complainants or deemed still insufficient for proving guilt. Thus, while digital evidence may be challenging typical criminal justice responses to sexual violence, it may equally be utilised (...) to buttress entrenched stereotypes and criminal justice practices that lead to complainant dissatisfaction and serve to support low conviction rates. I draw on critical feminist legal theory, feminist engagements with digital technology and sexual violence, and visual criminology to theorise the burgeoning role of the digital witness in sexual violence cases. (shrink)

How should we punish criminal offenders? One prima facie attractive punishment is administering a mandatory neurointervention—interventions that exert a physical, chemical or biological effect on the brain in order to diminish the likelihood of some forms of criminal offending. While testosterone-lowering drugs have long been used in European and US jurisdictions on sex offenders, it has been suggested that advances in neuroscience raise the possibility of treating a broader range of offenders in the future. Neurointerventions could be a cheaper, and (...) more effective method of punishment. They could also be more humane. Nevertheless, in this paper we provide an argument against the use of mandatory neurointerventions on offenders. We argue that neurointerventions inflict a significant harm on an offender that render them a morally objectionable form of punishment in a respect that incarceration is not. Namely, it constitutes an objectionable interference with the offender’s mental states. However, it might be thought that incarceration also involves an equally objectionable interference with the offender’s mental states. We show that even if it were the case that the offender is harmed to the same extent in the same respect, it does not follow that the harms are morally equivalent. We argue that if one holds that intended harm is more difficult to justify than harm that is unintended but merely foreseen, this means neurointerventions could be morally objectionable in a significant respect that incarceration is not. (shrink)

Whether it is fair to use personal responsibility of patients for their own health as a rationing criterion in healthcare is a controversial matter. A host of difficulties are associated with the concept of personal responsibility in the field of medicine. These include, in particular, theoretical considerations of justice and such practical issues as multiple causal factors in medicine and freedom of health behaviour. In the article, personal responsibility is evaluated from the perspective of several theories of justice. It is (...) argued that in a healthcare system based on both equality of opportunity and solidarity, responsible health behaviour can—in principle—be justifiably expected. While the practical problems associated with personal responsibility are important, they do not warrant the common knee-jerk refusal to think more deeply about responsibility for health as a means of allocating healthcare resources. In conclusion, the possibility of introducing personal responsibility as a fair rationing criterion is briefly sketched. (shrink)

There is a growing tendency for medicine to be used not to prevent or heal illnesses, but to fulfil individual personal wishes such as wishes for enhanced work performance, better social skills, children with specific characteristics, stress relief, a certain appearance or a better sex life. While recognizing that the subject of wish-fulfilling medicine may vary greatly and that it may employ very different techniques, this article argues that wish-fulfilling medicine can be described as a cohesive phenomenon with distinctive features. (...) Following a few examples of well established wish-fulfilling medical practices and a brief definition of the phenomenon, both theoretical aspects and ethical implications of such practices are discussed and the question is raised how wish-fulfilling medicine should be evaluated from an ethical point of view. It is concluded that modern medicine is currently ill equipped to provide reasons why wish-fulfilling medicine should be banned or discouraged. The phenomenon of wish-fulfilling medicine serves as a prime example of the vagueness of the descriptive and the lack of decisive orientation of the normative categories employed in modern medicine. (shrink)

The concept of lifestyle-related diseases and individual responsibility for health has played an important role in debates on the fair allocation of increasingly scarce health-care resources. In this article, we examine this discussion through the prism of solidarity. Based on an understanding of solidarity as shared practices reflecting a collective commitment to carry ‘costs’ (financial, social, emotional or otherwise) to assist others, we analyse frequent arguments in the debate and, in particular, the tool of risk-stratification. We then offer a solidarity-based (...) approach to understanding risk in the context of lifestyle-related diseases, and draw a number of conclusions on how health policy informed by solidarity should approach priority setting in health care. (shrink)

Media, police, and educational responses to nonconsensual pornography (i.e. ‘revenge porn’) have been critiqued for relying on sex negative beliefs that result in victims of this act being blamed and shamed for their own victimisation. In this article I analyse judicial discourse in nonconsensual pornography case law to assess the extent to which sex negativity is embedded in legal responses. I find that, while overt victim blaming and shaming is not present in the judicial discourse, subtle forms of sex negativity (...) are expressed in a minority of cases through references to consensual youth image sharing as inappropriate and through the framing of reputational harms. I argue that it is essential for legal responses to not only avoid sex negative narratives (as most currently do) but to actively reveal and counter the sex negative beliefs that underlie many of the harms associated with nonconsensual pornography. (shrink)

ZusammenfassungDer Beitrag nimmt eine zentrale ärztliche Tätigkeit im Rahmen des deutschen Sozialversicherungswesens in den Blick: die Begutachtung in Unfallrentenangelegenheiten. Am Beispiel des Kohlenbergbaus in der Zwischenkriegszeit rekonstruiert er, wie zuerst Sozialpolitiker den „Preßluftschaden“ als Berufskrankheit definierten, woraufhin Unfallchirurgen diesem sozialrechtlichen Tatbestand eine ärztliche Praxis abgewinnen mussten. Auf Grundlage medizinischer Fachpublikationen und der Archivalien des höchsten Spruchgremiums im Sozialrecht, des Reichsversicherungsamtes, wird die kontroverse Hervorbringung von neuem Wissen nachgezeichnet. Der Beitrag argumentiert, dass medizinisches Wissen in der Begutachtung weder einfach „angewandt“ noch (...) dass es kompromittiert wurde, wenn sich Ärzte an den Rationalitäten von Verwaltung und Rechtsprechung orientierten. Medizinische Begutachtung sollte stattdessen als eine spezifische Form des ärztlichen Wissens verstanden werden. (shrink)

ZusammenfassungIn der neueren deutschen Rechtsprechung wurden die Anforderungen an die rechtliche Zulässigkeit von Zwangsbehandlungen verschärft und der Berücksichtigung des natürlichen Willens nicht selbstbestimmungsfähiger Patienten ein höherer Stellenwert eingeräumt. So ist der behandelnde Arzt etwa verpflichtet, einen letzten Versuch zu unternehmen, eine auf Vertrauen gegründete Zustimmung zu erhalten. In Anbetracht dessen, dass ein solches Gespräch im Kontext informellen Zwangs stattfindet, ergibt sich ein medizinethisches Dilemma: Entweder wird eine Zwangsbehandlung durchgeführt und somit direkter körperlicher Zwang angewendet, oder eine Zustimmung wird erzielt, jedoch (...) gegebenenfalls um den Preis, dass informeller Zwang – z. B. in Form einer Drohung, Täuschung oder Manipulation – ausgeübt wird. Es wird dafür argumentiert, dass die Antwort auf dieses Problem im philosophischen Begriff der Anerkennung zu finden ist, der im vorliegenden Kontext als eine spezifische Haltung aufgefasst wird und sich in einem respektvollen Umgang des Klinikpersonals mit den betroffenen Patienten zeigt. Die Ausübung von Zwang ist in solchen Fällen kaum zu vermeiden. Dennoch kann man in dieser Situation besser oder schlechter mit dem Patienten umgehen – und besser heißt hier, dem Patienten Anerkennung entgegenbringen. (shrink)

Volume 34, Issue 8, December 2020, Page 1608-1620.

BackgroundThe EU’s 2006 Paediatric Regulation aims to support authorisation of medicine for children, thus effectively increasing paediatric research. It is ethically imperative to simultaneously establish procedures that protect children’s rights.MethodThis study endeavours (a) to evaluate whether a template consent form designed by the Standing Working Group of the German-Research-Ethics-Committees (AKEK) adequately informs adolescents about research participation, and (b) to investigate associated phenomena like therapeutic misconception and motives for research participation. In March 2016 a questionnaire study was conducted among 279 pupils (...) (mean age 13.1 years) of a secondary school in northern Germany.ResultsA majority of participants showed a general good understanding of foundational research ethics concepts as understood from the AKEK consent form. Nevertheless, our data also suggests possible susceptibility to therapeutic misconception. Own health concerns and pro-social considerations were found to be significant motivational factors for participating in research, while anticipation of pain lessens likelihood of participation. Advice from trusted others is an important decisional influence, too. Furthermore, data security was found to be a relevant aspect of adolescents’ decision-making process.ConclusionBearing in mind adolescents’ generally good understanding, we infer the lack of knowledge about medical research in general to be one source of therapeutic misconception. To further improve the quality of consent we propose a multi-staged approach whereby general research education is completed before an individual becomes a patient or potential participant. To the best of our knowledge this is the first German questionnaire-study addressing issues of informed consent in a large under-age sample. (shrink)

Die neue Reihe Ideen&Argumente ist dem Ideal einer pluralistischen und offenen Argumentationskultur verpflichtet und präsentiert in solider Ausstattung Themen und Fragestellungen, die inhaltlich oder methodisch wichtige Beiträge zur zeitgenössischen Philosophie leisten. Die Publikationen sollen die Vorzüge angelsächsischer und kontinentaler Philosophietraditionen in ein produktives Zusammenspiel bringen. Herausragende, systematisch ausgerichtete Originalausgaben und deutsche Erstausgaben aus allen Teilgebieten der Theoretischen und Praktischen Philosophie finden in Ideen&Argumente ihren Platz. Willkommen sind programmatische Monographien jeglicher philosophischer Provenienz. Es gilt, die zeitgenössische Philosophie in ihrer thematischen und (...) methodischen Vielfalt neu zur Geltung zu bringen. (shrink)

Die demografische Entwicklung und der medizinische Fortschritt werden die Problematik der Ressourcenknappheit im deutschen Gesundheitswesen in Zukunft weiter verschärfen. Soll nicht nur kurzfristig akuten Sparzwängen ausgewichen werden, steht – wie in verschiedenen Ländern bereits geschehen – auch Deutschland auf Dauer eine Prioritätensetzung im Gesundheitswesen bevor. Diese sollte in möglichst transparenter Weise nach klaren Kriterien erfolgen. Eines der seit einiger Zeit häufig öffentlich zitierten Kriterien der Verteilung von Mitteln in der Gesundheitsversorgung ist die Eigenverantwortung von Patienten. Deren Berücksichtigung in der Allokation (...) von Ressourcen birgt allerdings zahlreiche Probleme. Der vorliegende Beitrag untersucht die gerechtigkeitstheoretischen Grundlagen und die praktischen Probleme bzw. die möglichen Konsequenzen von Eigenverantwortung als Verteilungskriterium im Gesundheitswesen. Auf der Grundlage eines alternativen gerechtigkeitstheoretischen Vorschlags werden drei Möglichkeiten skizziert, Eigenverantwortung von Patienten im deutschen Gesundheitswesen in gerechter Weise stärker zu betonen. (shrink)

This paper argues that climate migration-in case of climate refugees in a strict sense-differs from other forms of migration not only by its finality but also by the fact that entire communities are forced to resettle elsewhere. For such communities to migrate with dignity-that is in a way that protects the social bases of their self-respect-their host countries are required to ensure the necessary institutional arrangements enabling these people to become full and equal members within a reasonably short time. Ensuring (...) that their equal participation rights are not merely formal but have ‘fair value’ requires taking cultural differences into account to ensure that they do not pose substantial disadvantages for participation in the political and social sphere. (shrink)

Disabled women's issues, experiences, and embodiments have been misunderstood, if not largely ignored, by feminist as well as mainstream disability theorists. The reason for this, I argue, is embedded in the use of materialist and constructivist approaches to bodies that do not recognize the interaction between “sex” and “gender” and “impairment” and “disability” as material-semiotic. Until an interactionist paradigm is taken up, we will not be able to uncover fully the intersection between sexist and ableist biases that form disabled women's (...) oppressions. Relying on the understanding that sexuality is one such material-semiotic phenomenon, I examine the operation of interwoven biases in two disabled women's narratives. (shrink)

Die demografische Entwicklung und der medizinische Fortschritt werden die Problematik der Ressourcenknappheit im deutschen Gesundheitswesen in Zukunft weiter verschärfen. Soll nicht nur kurzfristig akuten Sparzwängen ausgewichen werden, steht – wie in verschiedenen Ländern bereits geschehen – auch Deutschland auf Dauer eine Prioritätensetzung im Gesundheitswesen bevor. Diese sollte in möglichst transparenter Weise nach klaren Kriterien erfolgen. Eines der seit einiger Zeit häufig öffentlich zitierten Kriterien der Verteilung von Mitteln in der Gesundheitsversorgung ist die Eigenverantwortung von Patienten. Deren Berücksichtigung in der Allokation (...) von Ressourcen birgt allerdings zahlreiche Probleme. Der vorliegende Beitrag untersucht die gerechtigkeitstheoretischen Grundlagen und die praktischen Probleme bzw. die möglichen Konsequenzen von Eigenverantwortung als Verteilungskriterium im Gesundheitswesen. Auf der Grundlage eines alternativen gerechtigkeitstheoretischen Vorschlags werden drei Möglichkeiten skizziert, Eigenverantwortung von Patienten im deutschen Gesundheitswesen in gerechter Weise stärker zu betonen. (shrink)

: Disabled women's issues, experiences, and embodiments have been misunderstood, if not largely ignored, by feminist as well as mainstream disability theorists. The reason for this, I argue, is embedded in the use of materialist and constructivist approaches to bodies that do not recognize the interaction between "sex" and "gender" and "impairment" and "disability" as material-semiotic. Until an interactionist paradigm is taken up, we will not be able to uncover fully the intersection between sexist and ableist biases (among others) that (...) form disabled women's oppressions. Relying on the understanding that sexuality is one such material-semiotic phenomenon, I examine the operation of interwoven biases in two disabled women's narratives. (shrink)

In times of global economic and political crises, the notion of solidarity is gaining new currency. This book argues that a solidarity-based perspective can help us to find new ways to address pressing problems. Exemplified by three case studies from the field of biomedicine: databases for health and disease research, personalised healthcare, and organ donation, it explores how solidarity can make a difference in how we frame problems, and in the policy solutions that we can offer.

Die epidemiologische Morbiditätsverschiebung der vergangenen Jahrzehnte hat verhaltensassoziierte Erkrankungen in das Zentrum der Public Health-Arbeit rücken lassen. Sowohl die Prävention Lebensstil-bedingter Erkrankungen als auch die Behandlung ihrer Folgen gehören angesichts steigender Morbiditäts- und Mortalitätszahlen zu den größten Herausforderungen für moderne Gesundheitssysteme. Eine Beeinflussung von Gesundheitsverhalten sowie dessen Berücksichtigung in der Mittelverteilung – prominent verhandelt in der medizinethischen Debatte um gesundheitliche Eigenverantwortung – sind jedoch kontrovers. Bisher konnte dafür noch kein allgemein akzeptiertes theoretisches Modell entwickelt werden. Im vorliegenden Beitrag wird der (...) in letzter Zeit im angloamerikanischen Raum intensiv im Public Health-Kontext verhandelte libertäre Paternalismus als ein solches Modell untersucht und einer kritischen Untersuchung zugeführt. Es wird geschlussfolgert, dass dieses Modell zwar argumentativ in wesentlicher Hinsicht unterbestimmt ist, jedoch viele willkommene und sinnvolle Impulse für die moderne Public Health-Politik liefern kann. (shrink)

In its expansion to genomic, epidemiological and biomedical research, citizen science has been promoted as contributing to the democratisation of medical research and healthcare. At the same time, it has been criticised for reinforcing patterns of exclusion in health and biomedicine, and sometimes even creating new ones. Although citizen science has the potential to make biomedical research more inclusive, the benefits of current citizen science initiatives are not equally accessible for all people—in particular those who are resource-poor, located outside of (...) traditional networks of healthcare services, or members of minorities and marginalised groups. In view of growing public investments in participatory research endeavours, we argue that it should be considered more explicitly if, and how, citizen science could help make research more inclusive, contribute to the public good, and possibly even lead to better and more equitable healthcare. Reflecting on emerging ethical concerns for scientific conduct and best medical practice, we propose a set of relevant considerations for researchers, practitioners, bioethicists, funders and participants who seek to advance ethical practices of citizen-led health initiatives, and address profound differences in position, privilege and power in research. (shrink)

Die demografische Entwicklung und der medizinische Fortschritt werden die Problematik der Ressourcenknappheit im deutschen Gesundheitswesen in Zukunft weiter verschärfen. Soll nicht nur kurzfristig akuten Sparzwängen ausgewichen werden, steht – wie in verschiedenen Ländern bereits geschehen – auch Deutschland auf Dauer eine Prioritätensetzung im Gesundheitswesen bevor. Diese sollte in möglichst transparenter Weise nach klaren Kriterien erfolgen. Eines der seit einiger Zeit häufig öffentlich zitierten Kriterien der Verteilung von Mitteln in der Gesundheitsversorgung ist die Eigenverantwortung von Patienten. Deren Berücksichtigung in der Allokation (...) von Ressourcen birgt allerdings zahlreiche Probleme. Der vorliegende Beitrag untersucht die gerechtigkeitstheoretischen Grundlagen und die praktischen Probleme bzw. die möglichen Konsequenzen von Eigenverantwortung als Verteilungskriterium im Gesundheitswesen. Auf der Grundlage eines alternativen gerechtigkeitstheoretischen Vorschlags werden drei Möglichkeiten skizziert, Eigenverantwortung von Patienten im deutschen Gesundheitswesen in gerechter Weise stärker zu betonen. (shrink)

The right to conscientious objection in the provision of healthcare is the subject of a lengthy, heated and controversial debate. Recently, a new dimension was added to this debate by the US Supreme Court's decision in Burwell vs. Hobby Lobby et al. which effectively granted rights to freedom of conscience to private, for-profit corporations. In light of this paradigm shift, we examine one of the most contentious points within this debate, the impact of granting conscience exemptions to healthcare providers on (...) the ability of women to enjoy their rights to reproductive autonomy. We argue that the exemptions demanded by objecting healthcare providers cannot be justified on the liberal, pluralist grounds on which they are based, and impose unjustifiable costs on both individual persons, and society as a whole. In doing so, we draw attention to a worrying trend in healthcare policy in Europe and the United States to undermine women's rights to reproductive autonomy by prioritizing the rights of ideologically motivated service providers to an unjustifiably broad form of freedom of conscience. (shrink)

The right to conscientious objection in the provision of healthcare is the subject of a lengthy, heated and controversial debate. Recently, a new dimension was added to this debate by the US Supreme Court's decision in Burwell vs. Hobby Lobby et al. which effectively granted rights to freedom of conscience to private, for-profit corporations. In light of this paradigm shift, we examine one of the most contentious points within this debate, the impact of granting conscience exemptions to healthcare providers on (...) the ability of women to enjoy their rights to reproductive autonomy. We argue that the exemptions demanded by objecting healthcare providers cannot be justified on the liberal, pluralist grounds on which they are based, and impose unjustifiable costs on both individual persons, and society as a whole. In doing so, we draw attention to a worrying trend in healthcare policy in Europe and the United States to undermine women's rights to reproductive autonomy by prioritizing the rights of ideologically motivated service providers to an unjustifiably broad form of freedom of conscience. (shrink)

ZusammenfassungAllen Anstrengungen zur Erhöhung des Organaufkommens zum Trotz besteht in Deutschland und anderswo ein stetig wachsender Organmangel. Im vorliegenden Artikel wird eine Möglichkeit vorgestellt, die Zahl der verfügbaren Organe zu erhöhen: moderate finanzielle Anreize für die Postmortalspende. Es werden verschiedene Anreizmodelle dargestellt und zentrale ethische Argumente für und wider ihre Einführung diskutiert. Zu diesen gehören Gerechtigkeitsüberlegungen, die Sorge um ausreichende Freiwilligkeit potentieller Organspender, die Gefahr einer Schädigung des individuellen und gesellschaftlichen Altruismus sowie die Ablehnung von kommerzialisierten Vorgängen in der Medizin. (...) Es wird aufgezeigt, dass die Argumente gegen die im Artikel vorgestellten Formen moderater finanzieller Anreize nicht verfangen. Im Ausblick wird für eine sorgfältig geplante Pilotforschung zu Anreizmodellen in der postmortalen Organspende plädiert. (shrink)

ZusammenfassungDie demografische Entwicklung und der medizinische Fortschritt werden die Problematik der Ressourcenknappheit im Gesundheitswesen in Zukunft weiter verschärfen. Auch Deutschland steht eine Prioritätensetzung im Gesundheitswesen bevor. Diese sollte in möglichst transparenter Weise nach klaren Kriterien erfolgen. Ein nur selten in diesem Kontext besprochenes Kriterium der Verteilung von Mitteln in der Gesundheitsversorgung ist die marginale Wirksamkeit medizinischer Leistungen. Im vorliegenden Beitrag wird dieses Kriterium vorgestellt und auf seine Fairness hin untersucht. Nach der kritischen Diskussion einiger Argumente gegen den offenen Einsatz von (...) Rationierungskriterien und einer Definition von marginaler Wirksamkeit in zwei unterschiedlichen Dimensionen werden verschiedene Vorzüge und eventuelle Nachteile des Kriteriums beleuchtet. (shrink)